Minimally invasive image-guided therapy for inoperable hepatocellular carcinoma: What is the evidence today?

Abstract

Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver that accounts for an important health problem worldwide. Only 10–15% of HCC patients are suitable candidates for hepatic resection and liver transplantation due to the advanced stage of the disease at time of diagnosis and shortage of donors. Therefore, several minimally invasive image-guided therapies for locoregional treatment have been developed. Tumor ablative techniques are either based on thermal tumor destruction, as in radiofrequency ablation, cryoablation, microwave ablation, laser ablation and high-intensity focused ultrasound, or chemical tumor destruction, as in percutaneous ethanol injection. Image-guided catheter-based techniques rely on intra-arterial delivery of embolic, chemoembolic or radioembolic agents. These minimally invasive image-guided therapies have revolutionized the management of inoperable HCC. This review provides a description of all minimally invasive image-guided therapies currently available, an up-to-date overview of the scientific evidence for their clinical use, and thoughts for future directions.

Percutaneous radiofrequency ablation of hepatocellular carcinoma in cirrhosis: analysis of complications in a single centre over 20 years

“…Recently, several percutaneous ablation techniques, such as radiofrequency ablation (RFA), microwave ablation, cryoablation and laser-induced interstitial thermotherapy, are employed in treatment of hepatocellular carcinoma (HCC) in cirrhosis. [1][2][3] Percutaneous RFA has gained great popularity in the treatment of HCC in cirrhosis. [4][5][6] Several studies have shown its efficacy and high reproducibility elsewhere.…”

An automatic registration method for pre‐ and post‐interventional CT images for assessing treatment success in liver RFA treatment

“…In practice, radiologists typically compare the tumor region from preinterventional images to the ablation zone in post-interventional CT images to assess treatment success. [4][5][6] They mentally compare shape, size, and position of the tumor and the treated zone. For this evaluation, the treatment is considered successful if the tumor is completely enclosed by the ablation zone with a safety margin of 5 mm or larger.…”

Diagnosis and treatment of hepatocellular carcinoma: An update

“…The available data is sufficient to conclude that RFA significantly improves survival and decreases local recurrence when compared to PEI. PEI use should be limited to circumstances when RFA is unavailable or technically not possible [99,100] .…”